Polymicrobial Bacteriobilia Is Associated with 90-Day Mortality After Pancreaticoduodenectomy

Bacteriobilia is common in patients undergoing pancreaticoduodenectomy (PD), particularly after preoperative biliary drainage. Its impact on perioperative outcomes and extended early mortality remains controversial. This study evaluated the association between intraoperative bile cultures and early postoperative outcomes following PD for periampullary tumors.

This retrospective cohort study included 176 patients who underwent PD with intraoperative bile culture between 2013 and 2024 at a tertiary center. Patients were stratified according to bacteriobilia status. Perioperative variables, postoperative complications (Clavien-Dindo classification), and mortality at 30, 60, and 90 days were analyzed. Multivariable logistic regression identified independent predictors of bacteriobilia and early mortality.

Bacteriobilia was detected in 146 patients (83%), with 70% presenting polymicrobial cultures. Preoperative ERCP (OR 23.48; 95% CI 6.47-85.22; p<0.001) and biliary stent placement (OR 8.78; 95% CI 1.98-38.86; p=0.004) independently predicted bacteriobilia. Overall mortality was 12.5% at 30 days, 16.0% at 60 days, and 16.5% at 90 days. Bacteriobilia per se was not associated with increased major morbidity or mortality. However, polymicrobial bile cultures were independently associated with higher mortality at 60 (OR 2.32; 95% CI 1.35-3.88; p=0.004) and 90 days (OR 20.07; 95% CI 1.32-304.81; p=0.031), after adjustment for vascular resection, bleeding, transfusion, and severe complications.

Although bacteriobilia is highly prevalent after preoperative biliary drainage, it does not independently worsen perioperative outcomes. Polymicrobial bile cultures were associated with increased 60- and 90-day mortality and may identify a subgroup of patients with greater biological and perioperative complexity, highlighting the importance of microbiological stratification and extended mortality assessment after PD.